TITLE 28. INSURANCE
PART 2. TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
CHAPTER 137. DISABILITY MANAGEMENT
SUBCHAPTER
B.
INTRODUCTION. The Texas Department of Insurance, Division of Workers' Compensation (DWC) adopts amendments to 28 TAC §137.10, concerning return-to-work guidelines. Section 137.10 implements Texas Labor Code §413.011. The DWC medical advisor recommends the amendments to the commissioner of workers' compensation under Labor Code §413.0511(b).
The amendments to §137.10 are adopted without changes to the proposed text published in the July 31, 2026, issue of the Texas Register (51 TexReg 5000). Section 137.10 will not be republished.
REASONED JUSTIFICATION. The amendments adopt a different set of guidelines for disability duration values. The current rule requires the use of Medical Disability Advisor, while the adopted change requires the use of ODG by MCG, published by MCG Health (ODG by MCG). Amending §137.10 is necessary to instruct insurance carriers, health care providers, and employers to use the disability duration values in the current edition of the ODG by MCG instead of those in the MDGuidelines (formerly known as Medical Disability Advisor), as guidelines for the evaluation of expected or average return-to-work timeframes. The amendments also update DWC's website address and the section's effective date, and include nonsubstantive editorial changes that make updates for plain language and agency style to improve the rule's clarity.
Labor Code §413.011(e) requires the commissioner to adopt treatment guidelines and return-to-work guidelines by rule. Section 413.011(f) requires that those guidelines must be designed to ensure the quality of medical care and to achieve effective medical cost control, and to enhance a timely and appropriate return to work.
To fulfill their role in the Texas workers' compensation system, designated doctors are required to subscribe to these guidelines, which includes purchasing access to them. The current adopted treatment guidelines are published by ODG by MCG, and include access to return-to-work guidelines. Designated doctors cannot currently use ODG by MCG's return-to-work guidelines because the return-to-work guidelines in the current rule are published by MDGuidelines. MDGuidelines will change its pricing model and raise its rates substantially starting on October 1, 2026. Since the ODG by MCG treatment guidelines subscription already includes access to return-to-work guidelines, the amendments will allow system participants to use the ODG by MCG services they already subscribe to instead of maintaining a separate, costly subscription to MDGuidelines. Amending the rule to update the reference from Medical Disability Advisor to ODG by MCG is necessary to ensure continued participation in the workers' compensation system by avoiding unnecessary administrative and monetary burdens on doctors in the system. The change will promote efficiency by allowing system participants to benefit from a single subscription instead of maintaining two separate subscriptions to substantially similar services. Avoiding those unnecessary costs also complies with the requirement in Labor Code §413.011 that the commissioner's adopted return-to-work guidelines help achieve effective medical cost control.
The return-to-work guidelines in ODG by MCG are comparable to those in MDGuidelines, and moving to the guidelines in ODG by MCG makes sense administratively, economically, and clinically. Both sets of guidelines derive disability duration values from the same foundational methodology--population-based epidemiological data stratified by diagnosis, job classification, and physical demand characteristics. The underlying evidence base for expected return-to-work timeframes does not differ materially between the two sets of guidelines. In practice, duration values calculated using both sets of guidelines have been substantively equivalent across the overwhelming majority of diagnostic categories in Texas workers' compensation claims. As a result, replacing the return-to-work guidelines with those in ODG by MCG removes an unnecessary cost and duplication of resources without any loss of clinical accuracy or adjudicative reliability. In addition, because treatment and expected disability duration are evaluated together, using the ODG by MCG for both treatment, as is currently the case, and return-to-work disability duration calculations, as this order adopts, allows system participants to apply a single, integrated, evidence-based resource across both the treatment and return-to-work functions, which more accurately reflects actual clinical decision making.
As part of the implementation plan for this rule, DWC intends to train system participants on the use of the return-to-work guidelines in ODG by MCG.
DWC invited public comments on an informal draft posted on DWC's website on May 6, 2026, as well as on the formal proposal. DWC also held a public hearing on the proposal on August 24, 2026. DWC considered the comments it received when drafting this order.
SUMMARY OF COMMENTS AND INFORMATION SUBMITTED, AND AGENCY RESPONSE.
Commenters: DWC received six written comments by the August 31, 2026, deadline, and no oral comments at the August 24, 2026, hearing. All of the commenters included information, data, research, or analysis about the cost, benefit, or effect of the proposal. Commenters in support of the proposal were: Cheryl Olson, Sheryl Lawson, and Eleanor Armstrong for Britt Case Management; the State Office of Risk Management; the Office of Injured Employee Counsel; and Texas Mutual Insurance Company. No commenters requested changes, and no commenters were against the proposal.
Comments on §137.10. Every other state accepts ODG for treatment guidelines and return to work. Switching to ODG for return to work would be more efficient and in line with other states.
Agency Response to Comments on §137.10. DWC appreciates the comments and agrees.
Comment on §137.10. Streamlining the return-to-work guidelines with the adopted medical treatment guidelines under ODG promotes consistency, enhances efficiency, and lowers costs across the workers' compensation system.
Agency Response to Comment on §137.10. DWC appreciates the comment and agrees.
Comment on §137.10. Decreasing workers' compensation system costs is beneficial to the injured employees of Texas.
Agency Response to Comment on §137.10. DWC appreciates the comment and agrees.
Comment on §137.10. Because ODG by MCG incorporates both treatment and return-to-work guidelines within a single subscription, the proposed amendments would allow carriers and doctors to maintain a single ODG by MCG subscription while retaining access to both sets of guidelines at no additional cost.
Agency Response to Comment on §137.10. DWC appreciates the comment and agrees.
STATUTORY AUTHORITY. The commissioner of workers' compensation adopts the amendments to 28 TAC §137.10 under Labor Code §§413.011, 402.00111, 402.00116, and 402.061.
Labor Code §413.011(e) requires the commissioner to adopt treatment guidelines and return-to-work guidelines by rule. Section 413.011(f) states that the medical policies or guidelines the commissioner adopts in subsection (e) must be: (1) designed to ensure the quality of medical care and to achieve effective medical cost control; (2) designed to enhance a timely and appropriate return to work; and (3) consistent with §§413.013, 413.020, 413.052, and 413.053.
Labor Code §402.00111 provides that the commissioner of workers' compensation shall exercise all executive authority, including rulemaking authority under Title 5 of the Labor Code.
Labor Code §402.00116 provides that the commissioner of workers' compensation shall administer and enforce this title, other workers' compensation laws of this state, and other laws granting jurisdiction to or applicable to DWC or the commissioner.
Labor Code §402.061 provides that the commissioner of workers' compensation shall adopt rules as necessary to implement and enforce the Texas Workers' Compensation Act.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on September 8, 2026.
TRD-202603910
Kara Mace
General Counsel
Texas Department of Insurance, Division of Workers' Compensation
Effective date: September 28, 2026
Proposal publication date: July 31, 2026
For further information, please call: (512) 804-4703